Dr. Vincent Giacalone
Podiatric Medicine & Surgery
466 Hook Rd., Suite 24D, Emerson, NJ 07630
What is a Bunion?
A bunion (from the Latin “bunio,” meaning enlargement) is an enlargement of the bone on the inner side of the big toe joint. Normally the bones, tendons and ligaments work together to transmit and distribute the body’s weight and forces, especially during movement. Should this joint become abnormally stressed over an extended period of time, a bunion deformity may result. Bunions usually begin when the big toe starts moving toward the second toe. This puts pressure on the joint, pushing it outward. The movement of the joint in this outward direction starts the formation of a bunion.
A common deformity of the big toe joint, a bunion begins to hurt while wearing shoes. Women are more frequently affected with bunions because of tight, pointed, confining or high-heeled shoes. Wearing high heels is especially stressful on the joints of the foot because more of the body’s weight rests there. The foot is then forced into a narrow, pointed shoe, compounding the problem. Older people are also vulnerable to bunions because of the higher incidence of arthritis affecting the big toe joint.
What Causes a Bunion?
A bunion is most often a symptom of faulty mechanics of the foot. The deformity runs in families, but it is the foot type that is hereditary, not the bunion. People with flat feet or low arches are more prone to develop the problem than those with higher arches. Bunions also may be associated with various forms of arthritis. Arthritis can cause the joint’s protective covering of cartilage to deteriorate, leaving the joint damaged and with a decreased range of motion. Parents who have bunions should know that there is a strong hereditary predisposition to bunion development, and should have their children evaluated if early signs of deformity and/or discomfort are evident. If the child has the same foot type, there is a possibility that a bunion will eventually develop.
What are the Symptoms?
Pain from a bunion can be mild, moderate or severe, making it difficult to walk in normal shoes, especially high-heeled shoes. The skin and tissues around the bunion also may be swollen or inflamed. The other toes can be affected by a bunion, as a result of pressure from the great toe pushing toward the lesser toes. Toenails may begin to grow into the sides of the toe, the smaller toes can develop corns and become bent (hammertoes); or calluses may form on the bottom of the foot.
What are the Treatments?
Treatments vary depending on the severity of pain and deformity. Left untreated, bunions tend to get larger and usually more painful. Evaluation by Dr. Giacalone should be sought at the first sign of pain or discomfort, so that severe deformity can be avoided. The main goal of early treatment is to relieve pressure on the bunion and smaller toes, and to diminish the progression of joint deformities.
Padding: The bunion is an important first step, as is wearing shoes that are large enough to comfortably accommodate the bunion (such as sandals, athletic shoes or shoes made from soft leather). Stiff leather shoes may be stretched slightly for greater comfort. Tight, confining or high-heeled shoes should be avoided.
Medications: Medication such as non-steroidal anti-inflammatory drugs (such as Advil or Motrin) or cortisone injections, may be prescribed to ease pain and inflammation caused by joint deformities.
Physical therapy: Ultrasound treatment, whirlpool baths or other techniques can also provide temporary relief.
Orthotics: Orthotics may be useful in controlling abnormal foot movement and may reduce symptoms for those with a painful bunion that has not yet caused a significant bony abnormality at the joint. If a systemic disease like rheumatoid arthritis or gouty arthritis is related to the bunion, appropriate medical treatment may be recommended.
What is the Surgical Treatment?
When conservative treatment does not provide satisfactory relief from symptoms, or when the condition interferes with your activities, surgery may be recommended. Pain and deformity are significantly reduced in the great majority of patients who undergo bunion surgery. In addition to easing pain, the purpose of bunion surgery is to remove the enlargement and realign the joint to restore normal function. This means that after surgery, the foot can carry the body’s weight properly, and that special shoes are no longer needed. Postoperative orthoses or supportive devices may be recommended to improve foot function. Surgery may be performed at a hospital or surgical center. Depending on the procedure, the facility and the patient’s medical status, Dr. Giacalone may recommend local anesthesia with intravenous (IV) sedation or general anesthesia. In many cases, the procedure can be performed under local anesthesia with IV sedation by an anesthesiologist.
What are the Types of Surgery?
There are several surgical procedures used to correct bunions. The decision to use a particular procedure is based on the severity of the deformity, x-ray findings, the patient’s age, the health of the patient, their activity level, and the health of the bones and connective tissue as well as other factors. The guidelines for types of surgery are: Mild, Moderate or Severe Bunion and Arthritic Bunion or big toe joint. For a mild bunion, the enlarged portion of bone may be removed and the muscles, tendons and ligaments surrounding the joint may be realigned. For a moderate bunion, the bone may be cut and shifted into its proper position. Whether or not the bone is cut depends on the severity and location of the deformity. In addition, the surrounding tendons and ligaments may need to be repositioned. For a severe bunion, a combination of the following procedures may be necessary: removal of the enlarged portion of the bone; cutting and realignment of the bone; and correction of the tendons and ligaments. If the joint is damaged beyond repair (commonly seen in arthritis), it may need to be reconstructed or replaced with an artificial joint. Joint replacement implants may be used in the reconstruction of the big toe joint.
Following surgery to correct a mild or moderate bunion, the foot is bandaged and a walking boot or postoperative shoe is usually worn for three to four weeks. The amount of activity allowed will vary, and it may be suggested that flexible footwear be worn for several weeks after wearing a boot or postoperative shoe.
If the bone was cut, as in surgery for a moderate to severe bunion, it may be held in place with an internal screw. In many cases, a lower leg cast may be required for four to six weeks, and walking is assisted by crutches.
Movement of the toe joint is important after any type of bunion surgery. Specific instructions for exercising the joint will be provided by Dr. Giacalone and a physical therapist. After the foot has healed, and if the bunion was the result of improper foot function or foot type, the cause of the problem should be addressed. Orthotics may be prescribed to protect the foot and improve its function.
What Should I Expect After Surgery?
For a few weeks following the surgery the foot and the joint may remain swollen and slightly stiff and not be as flexible as before the surgery. Physical therapy will be prescribed and gradual return to normal activity will be noted as healing progresses over the course of several months. As the patient you are an active participant in the healing process and equally responsible for the post operative care. Your adherence to Dr. Giacalone’s instructions and physical therapy regimen is an important part of maximizing your results.
What are the Risks?
Some risks when considering bunion surgery include joint stiffness, mal-alignment, joint pain, infection and recurrence. Dr. Giacalone will discuss the risks as it pertains to your particular case. The ultimate goal is to relieve pain and prevent the bunion from recurring.
Dr. Giacalone has been trained specifically and extensively in the diagnosis and medical and surgical treatment of foot disorders. Dr. Giacalone has been board certified by The American Board of Podiatric Orthopedics and The American Board of Podiatric Surgery since 1993 and 1995 respectively and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Giacalone performs surgery at Hackensack University Medical Center in Hackensack, Hackensack University Medical Center @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.